Action T4 (German: Aktion T4) was a program in Nazi Germany officially between 1939 and 1941, during which the regime of Adolf Hitler systematically killed between 75,000 to 250,000 people with intellectual or physical disabilities. Unofficially performed after 1941, the killing became less systematic.

Background
Hitler had always been in favour of killing those whose lives he judged to be "unworthy of life." Both his physician, Dr Karl Brandt, and the head of the Reich Chancellery, Hans Lammers, testified after the war that Hitler had told them in 1933, at the time the sterilization law was passed, that he favoured killing the incurably ill, but recognized that public opinion would not accept this. Catholic institutions, which could be expected to bitterly resist the killing of their patients, were progressively closed and their inmates transferred to already overcrowded state institutions, where the squalid conditions provided further ammunition for campaigns in favour of "euthanasia."

Killing of children
Brandt and Bouhler soon developed plans to expand the program to adults. In July 1939 they had held a meeting attended by Dr Leonardo Conti, Reich Health Leader and state secretary for health in the Interior Ministry, and Professor Werner Heyde, head of the SS medical department. This meeting had made preliminary arrangements for a national register of all institutionalized people with mental illnesses or physical disabilities.
The first adults with disabilities to be killed by the Nazi regime were not however Germans but Poles, as the SS men of Einsatzkommando 16 cleared the hospitals and mental asylums of the "Wartheland", a region of western Poland which was earmarked for incorporation into Germany and resettlement by ethnic Germans following the German conquest of Poland. In the Danzig (now Gdańsk) area, some 7,000 Polish inmates of various institutions were shot, while 10,000 were killed in the Gdynia area. Similar measures were taken in other areas of Poland destined for incorporation into Germany. He described how the inmates of various asylums were removed and transported by bus to Hartheim. Some were in no mental state to know what was happening to them, but many were perfectly sane and for them various forms of deception were used. They were told they were at a special clinic where they would receive improved treatment, and were given a brief medical examination on arrival. They were then induced to enter what appeared to be a shower block, where they were gassed with carbon monoxide (this ruse was later used on a much larger scale at the extermination camps).

Killing of adults
Hitler and his colleagues were aware from the start that a program of killing large numbers of Germans with disabilities would be unpopular with the German public. Although Hitler had a fixed policy of not issuing written instructions for policies relating what would later be classed as crimes against humanity Kershaw estimates that by the end of 1941 75,000 to 100,000 people had been killed as a result of the program, but that further tens of thousands of concentration camp inmates, and people judged incapable of work, were killed in Germany between 1942 and 1945 (this figure does not include the Jews who were deported to their deaths in 1942 and 1943). Hartheim, for example, continued to kill people sent to it from all over Germany until 1945.

Opposition
In December 1946, an American military tribunal (commonly called the Doctors Trial) tried 23 doctors and administrators for their roles in war crimes and crimes against humanity. These crimes included the systematic killing of those deemed "unworthy of life," including the mentally retarded, the institutionalized mentally challenged, and the physically impaired. After 140 days of proceedings, including the testimony of 85 witnesses and the submission of 1,500 documents, in August 1947 the court pronounced 16 of the defendants guilty. Seven were sentenced to death and executed on 2 June 1948. They included Dr Karl Brandt and Viktor Brack.
The indictment read in part:
14. Between September 1939 and April 1945 the defendants Karl Brandt, Blome, Brack, and Hoven unlawfully, willfully, and knowingly committed crimes against humanity, as defined by Article II of Control Council Law No. 10, in that they were principals in, accessories to, ordered, abetted, took a consenting part in, and were connected with plans and enterprises involving the execution of the so called "euthanasia" program of the German Reich, in the course of which the defendants herein murdered hundreds of thousands of human beings, including German civilians, as well as civilians of other nations. The particulars concerning such murders are set forth in paragraph 9 of count two of this indictment and are incorporated herein by reference.
Also in 1945, seven staff members of the Hadamar institute were tried for the killing of Soviet and Polish nationals, but not for the large-scale killing of German nationals at the institute. Alfons Klein, Karl Ruoff and Wilhelm Willig were sentenced to death and executed, the other four were given long prison sentences.[1]
Philipp Bouhler and Leonardo Conti killed themselves in captivity in May 1945, while Dr Ernst-Robert Grawitz killed himself shortly before the fall of Berlin. Dr Friedrich Menneke died in 1947 while awaiting trial. Paul Nitsche was tried and executed by an East German court in 1948. Werner Heyde, after having escaped detection for 18 years, killed himself in 1964 before being brought to trial. Dr Heinrich Gross escaped justice.

Postwar events
The program is commonly described as one of "euthanasia," and this expression was used at the time by some of the officials responsible for carrying the program out, but it had little in common with euthanasia as this term is usually defined. It was not motivated by concern for the welfare of the people concerned or by a desire to release them from suffering – most of those killed were not suffering. It was carried out primarily according to the dictates of "racial hygiene" ideology, and secondarily to reduce the cost to the state of maintaining people with disabilities at a time when the overwhelming financial priority of the regime was rearmament. It was nearly always carried out without the consent of the people concerned or their families.
Professor Robert Lifton, author of The Nazi Doctors and a leading authority on the T4 program, makes clear the difference between this program and genuine euthanasia. He explains that the Nazi version of "euthanasia" was based on the work of Adolf Jost, who published The Right to Death (Das Recht auf den Tod) in 1895. Lifton writes: "Jost argued that control over the death of the individual must ultimately belong to the social organism, the state. This is in direct opposition to the Anglo-American concept of euthanasia, which emphasizes the individual's "right to die" or "right to death" or "right to his or her own death," as the ultimate human claim. In contrast, Jost was pointing to the state's right to kill."

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